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MPTAST) Under the Madhya Pradesh Health Sector Reforms Program (MPHSRP

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MPTAST) Under the Madhya Pradesh Health Sector Reforms Program (MPHSRP Madhya Pradesh Technical Assistance and Support Team (MPTAST) under the Madhya Pradesh Health Sector Reforms Program (MPHSRP) March 2015 Submitted to: Department for International Development, UK Submitted by: Madhya Pradesh Technical Assistance and Support Team (MPTAST) FHI 360 H-5, GROUND FLOOR, GREEN PARK EXTENSION NEW DELHI 110 016 TEL: 91-11-4048- 7777 www.fhi360.org Introduction Moving ahead in the direction of universal health coverage, the Dept. of Public Health and Family Welfare of the Government of Madhya Pradesh has taken various initiatives. With a plethora of service additions, widespread public welfare schemes and better monitoring systems, a new platform for health service delivery was launched in the year 2013. The platform aimed at decentralization of basic health services up to village level and utilized the existing platform of Anganwadi Centers and resource pool of ASHAs which already existing in villages providing nutrition and health services separately. The innovation brought in a much sought after convergence of the department of ICDS , Health and Panchayti Raj and foundation for development of village level health units called Gram Arogya Kendra (GAK) was laid down. The Gram Arogya Kendra were established at the existing anganwadi centres and ASHAs were trained to the new role envisaged for them. Service Provision at GAK Services provided by ANM: Conducting VHND, Providing ANC & PNC services during VHNDS, Conducting 5 provisioned tests (Hemoglobin, Urine Pregnancy test, Malaria test by RD kit, Urine albumin and Sugar test) in cases where needed and Immunization. Services Provided by ASHA: Dispensing medicines for minor ailments and seasonal diseases Maintaining village health register- Details of village health problems, target couples, pregnant mother, high risk mothers, births, deaths etc. Meeting of adolescent girls & health counselling Meetings of Village health & sanitation committee / Gram Sabha Swasth Gram Tadarth Samiti. Support provided by MPTAST to the state The Anganwadi cum Gram Arogya Kendra at Kankarkheda village, Sehore district. In order to help the state in smooth functioning of these village level units, MPTAST provided support in assessment and gap filling at these centers in terms of delivery of services by catalyzing availability of human resources, hands on training to ASHA and ANM, mobilizing supplies- drugs and consumables and stimulating VHSNCs to oversee the functioning of the GAKs. To strengthen the Gram Arogya Kendra in a structured way which can be presented as a model for the state, 2 blocks in each of the 16 TAST supported districts were identified, list which is followed in the table below: 2 List of Blocks and number of GAKs- MPTAST SN Districts of Blocks 1 GAKs Block 2 GAKs MPTAST 1 Sehore Icchawar 131 Shyampur 244 2 Alirajpur Sondhwa 133 Ambuwa 86 3 Dhar Gandhwani 144 Badnawar 164 4 Jhabua Kalyanpura 126 Thandla 111 5 Barwani Rajpur 85 Pati 110 6 Jabalpur Shahpura 209 Patan 165 7 Mandla Mohgaon 87 Beeja Dandi 132 8 Dindori Samnapur 114 Dindori 191 9 Rewa Sirmour 242 Raipur 236 10 Sidhi Majholi 129 Rampur 190 11 Satna Amarpatan 169 Majhgawan 296 12 Sagar Kesli 162 Rahatgarh 185 13 Chhatarpur Badamalhera 152 Raj Nagar 120 14 Tikamgarh Niwari 123 Jatara 170 15 Damoh Tedukheda 132 Damoh 237 16 Panna Pawai 249 Gunnor 120 TOTAL 2387 2757 GRAND TOTAL 5144 3 Methodology To improve the organization of services and service delivery at Gram Arogya Kendras, the district team members were oriented on the kind of support to be provided to the districts. For the purpose of structuring the efforts being given by district teams, a structured tool was adopted. This was developed by the state ASHA cell, and has enlisted the essential requirements at the GAKs (Please refer to the checklist annexed with this document). After district teams were oriented on checklist, the following protocol was developed for supportive supervision. 1. Prior information to district authorities before visiting any GAK 2. Prior telephonic consultation with the ASHA/ ANM of the area 3. A government official i.e. SMO/Sector supervisor/ANM/MPW to accompany the TAST team member during the visit 4. To carry few of the critical logistic items with the visiting team in case it is in shortage at the GAK and can be replenished hands on. 5. To visit GAK preferably on a Village Health and Nutrition Day (VHND). 6. To carry a functionality assessment of the center on the basis of checklist. 7. To provide hands on solutions, recommendations, hands on training for service delivery to the GAK workers- ASHA and ANM is available on site 8. To fill the checklist hard copy at the end of the visit and mention ‘action taken’ based on the support provided for each item in the checklist. 9. To inform the assessment findings, support provided and support needed further to the district officials 10. To follow-up of further the progress with the district & block officials 4 Monitoring of the GAK strengthening activities 1. For the monitoring of the GAKs in all 50 districts, state was supported with development of web based monitoring system. This is in form of a website called “community action or ASHA” website. The website was developed and is maintained by MPTAST consultant at the state ASHA cell. The website has a block level entry system for the GAK assessment based on the checklist. The data can be compiled for each block, district and for whole state and various analytics can be developed through it to see the development happening at GAKs at various levels. It can generate periodic data for GAK functionality status. The readily available reports can be seen for progress of any GAK based on the checklist parameters. It can further categorize GAKs into A, B, C & D categories for any given district, block or for the whole of Madhya Pradesh. The link for ASHA website: http://mpsdc.gov.in/mpasha/ Snapshot of ASHA Website 2. For the monitoring of assessment and improvements done by the district TAST team members, a data entry tool was developed. This was an excel sheet based tool and provided live data entry option to the district teams and has an automated compilation system at the district and state level. 5 Results The structured support provided by TAST to the GAKs using checklist based assessment and improvement was started from April 2014. During the initial months, all district team members including TO health, TO WASH, TO Nutrition and DPCs used the checklist for this exercise and helped their respective districts in identified blocks to improve the functionality of the GAKs. Eventually, the exercise has been conducted by the TO health in their respective districts. Starting from April 2014, till the end of March 2015, a total of 1020 GAKs have been assessed and have been provided with hands on support for improvement in its service delivery. The number, however, varies from district to district. The grading of the functional status of the GAKs based on the checklist scores was done into three categories. At the start of the exercise, during the month of April, 2014, a total of 112 GAKs were visited and their categorization based on the checklist was done. Which showed only 19% to be in category C, 28% in category B and 53% in category C. After the continuous efforts of the district teams, institutionalization of regular supportive supervision mechanism in districts and repeated guidance from the district authorities the situation looks much improved now. Till the end of March out of a total of 1020 GAKs supported, only 15% fall in category C, 56% in category B and 29% are in category A. Categories of 669 GAKs based on the checklist scores (April -September 2014) District wise status & categories: GAK supported Category A Category B Category C District (April-Sep 2014) Alirajpur 48 16 29 3 Badhwani 28 5 19 4 6 Chhatarpur 130 11 86 33 Dhar 64 51 13 0 Dindori 74 6 62 6 Damoh 37 17 20 0 Jabalpur 43 5 30 8 Jhabua 68 9 51 8 Mandla 59 8 37 14 Panna 33 10 20 3 Rewa 84 12 60 12 Sagar 25 11 9 5 Satna 30 1 12 17 Sehore 148 87 50 11 Sidhi 80 34 36 10 Tikamgarh 69 17 36 16 Total 1020 300 570 150 Status of parameters on assessment checklist: The assessment checklist for the GAKs has a total of 57 parameters and these parameters are sub grouped into four areas. The first section is of infrastructure and basic amenities (13 parameters), the second is availability of instruments and furniture (24 parameters), the third is about availability of medicines and consumables (13 parameters) and last section contains the details of informations available & displayed at GAKs (7 parameters). Each of the Gram Arogya was visited at least once for assessment on the checklist parameters and follow up was done by indirect methods like telephonic confirmation from the ASHA or 7 ANM or the block community mobilizer visiting the village afterwards. Further, few of the GAKs were randomly visited by district/ state teams to understand and validate the quality of data received. The checklist scores for various parameters were compared for the scored by deducting the “actions taken” from the final checklist scores for each parameter. The comparative status showing the improvement in parameters, four all four sections are mentioned in the graphs below. The improvement brought about by TAST efforts is prominently visible for most of the checklist items and can be largely attributed to mobilization of basic furniture, instrument, drugs and consumables. Few of the common issues identified and the action taken to resolve them in the districts are summarized below along with the graphs depicting the improvement.
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